Surgical Career Choices Research Articles

Systematic review of the efficacy and purpose of student surgical interest groups.

There is concern around projected unmet need in the surgical workforce internationally. Current barriers to medical students pursuing surgical careers include lack of early exposure, low confidence in surgical skills, and perceived lifestyle barriers. This review aimed to examine both the purpose of student surgical interest groups (SIGs) globally, and their effect on metrics representing student surgical career interest. barriers. MEDLINE, EMBASE, PubMed, and Google Scholar were searched for papers analysing surgical interest group purpose and efficacy. Risk of bias was assessed for survey-based papers using a 20-point checklist. Descriptive analysis was performed based on qualitative data. Twenty-eight papers were included in the analysis including 13 surveys. These were of moderate quality. The analysed SIGs had 100-1000 student members and a diverse range of funding sources. Purpose of SIGs was described by 26 of 28 papers with common themes including promotion of surgical career choice and developing theoretical/practical surgical skills. Common initiatives of SIGs included surgical lectures/teaching and practical skills workshops. Data from 15 papers analysing efficacy of SIGs suggested they positively influenced self-reported student interest in surgical careers (78.6%) and confidence in surgical knowledge (80%), as well as confidence in practical skills, knowledge about surgical careers/lifestyle, mentorship opportunity, and research involvement. Student SIGs make a unique contribution to early medical student experience through positive effect on promoting surgical careers. They target relevant metrics such as surgical knowledge and confidence that are known to influence surgical career choice in the modern surgical landscape.

Early Barriers to Career Progression of Women in Surgery and Solutions to Improve Them: A Systematic Scoping Review.

This study aims to summarize the evidence concerning the barriers that exist to the career progression of women in surgery and to provide potential solutions to overcome these obstacles. Visible and invisible impediments can hinder female doctors' pursuit of a surgical career, from choosing a surgical specialty to training opportunities and all the way through career progression. Database search of original studies about barriers for female surgeons during choice of surgical career, residency, and career progression. A query including possible solutions such as mentorship and network was included. Of 4618 total articles; 4497 were excluded as duplicates, having incorrect study focus, or not being original studies; leaving 120 studies meeting the inclusion criteria. Of the articles included, 22 (18%) focused on factors affecting the pursuit of a surgical career, such as surgical work hours and limited time for outside interests, 55 (46%) analyzed the main barriers that exist during surgical residency and fellowship training, such as discrimination and sexual harassment, 27 (23%) focused on barriers to career advancement, heavy workloads, ineffective mentorship, unclear expectations for advancement, inequality in pay or work-home conflicts. Among studies reporting on possible solutions, 8 (6.5%) articles reported on the role of effective mentorship to support career advancement and to provide moral support and 8 (6.5%) on the emerging role of social media for networking. Our analysis showed how different impediments hinder surgical career progression for women, with notable consequences on burnout and attrition. Identification and recognition of obstacles to career progression is the first step to addressing the gender gap in surgery. Active strategies should be improved to promote a culture of diversity and to create equal opportunity for women in surgery, while implementing structured mentoring programs and investing on an adequate communication on social media to engage the future generations.

Surgical career choices of medical students in China: does gender bias play a role?

BackgroundGender bias in career choices has always been a matter of great concern, including in the field of medicine. This study reports on the current situation in this regard in China, including the reasons for Chinese medical students’ willingness to engage in surgical careers; investigates their accounts of gender bias; and analyzes the effect of gender bias on their surgical career choices.MethodsThis study invited medical students from Harbin Medical University to fill out a non-mandatory questionnaire on whether they had witnessed gender bias, their surgical career intentions, and factors influencing their career intentions. A one-way analysis of variance was used to compare the differences between continuous variables. Pearson’s chi-squared test was used to compare the differences between the categorical variables, the Kendall correlation coefficient (tau) was used to assess the correlation between the reasons rankings reported by gender, and a multiple regression analysis was conducted by logit model.ResultsA total of 643 students responded to the questionnaire. Of them, 63.76% expressed a willingness for a surgical career, with “interest” being a key driving factor (73.41%). Almost all respondents (96.27%) answered that there were more male leaders in the surgical departments they had rotated through or had contacted. Only a few respondents reported gender barriers influencing recruitment (32.19%). However, witnessing gender bias (recruitment of male required) was correlated to choice of surgical career (P < 0.05). Females were less willing to pursue a career in surgery if they had witnessed gender barriers in surgical recruitment. Male dominance also correlated to the choice of a surgical career (P < 0.1). Of the respondents, 53.19% believed that surgery was not suitable for females; among female respondents, this number was 56.12%, higher than for male respondents. When females think that the surgical profession is not suitable for them, it reduces the possibility of their pursuing a career in surgery.ConclusionMost medical students were interested in surgical care. Witnessing gender bias decreases females’ willingness to pursue a career in surgery. It is necessary to stimulate medical students’ interest in surgery when formulating strategies to promote surgical career choices, as well as to reduce gender bias in surgery; in this way, females’ surgical careers should be ensured.

Role models as a factor influencing career choice among female surgical residents in Saudi Arabia: a cross-sectional study

Background and purposeRole models in the medical field are professional and experienced persons whose actions unconsciously inspire juniors to strive to be like them. To our knowledge, no studies have examined whether having a female surgical role model has influenced women to pursue a surgical career in Saudi Arabia. Hence, we sought to evaluate whether identifying role models in surgery influences career choice and defined the ideal qualities of a surgical role model as perceived by newly qualified doctors.MethodsWe employed a cross-sectional, survey- based study design, conducted between June 2020 and January 2021, in which female surgical residents completed a questionnaire about their perceptions and influence of role models in general surgery specialty at the time they pursue a career in surgery.ResultsA total of 51 respondents completed the questionnaire. The majority of them (78.4%) had a role model and (19.6%) indicated that their role model was a female. Of those who had a role model, (67.5%) agreed that they experienced a positive influence on their surgical career choice. Clinical and operation skills were reported as the most remarkable factor to be considered in their role models. Working directly with a male surgical consultant and female surgical residents imprinted a positive influence but this did not reach a statistical significance.ConclusionThe findings of this article contribute empirically to the strong effects of the same-sex role models and highlight the curial role of surgical residents in influencing female’s career choices in general surgery as an achievable and attainable domain. Which encourage the creation of national mentorship programs and exploring more in barriers for pursuing a surgical career.

SP2.2.15MRCS performance predicts surgical career outcomes

Abstract Aims Successful completion of the MRCS examination is mandatory for progression into higher surgical (registrar) training in the UK. National selection for training programmes is a highly competitive process. Despite this, the ranking of applicants does not currently include MRCS performance scores. This offers a unique opportunity to compare two independent assessments of surgical trainees to establish whether MRCS performance can predict future surgical career outcomes and competitiveness in training. Methods All UK candidates who attempted MRCS between 2007-2020 were matched to career outcome data using the GMC list of registered medical practitioners and anonymised (n = 2910). Chi-squared tests determined associations with first attempt MRCS pass/fail outcomes. Multinomial regression models were developed to establish the predictive power of success at MRCS in determining surgical specialty and training deanery choices. Results There was statistically significant variability in MRCS Part A pass rates, ranging from 55.1%-76.7% between surgical specialties (P = 0.001) but no significant variability in Part B pass rates (P = 0.655). There was significant variability in Part A and Part B pass rates between training deaneries (P = 0.010 and P = 0.036 respectively). Pass rates ranged from 59.9%-77.7% for Part A and 70.1%-85.0% for Part B between training deaneries. Those in more competitive specialties and training deaneries performed better in MRCS in terms of first attempt pass rate, scores and number of attempts taken to pass. Conclusion MRCS performance is an early predictor of surgical career choice and competitiveness. Trainees who perform well at MRCS are more likely to enter competitive surgical specialties and training deaneries.

238 MRCS Performance Predicts Surgical Career Outcomes

Abstract Aim Successful completion of the MRCS examination is mandatory for progression into higher surgical (registrar) training in the UK. National selection for training programmes is a highly competitive process. Despite this, the ranking of applicants does not currently include MRCS performance scores. This offers a unique opportunity to compare two independent assessments of surgical trainees to establish whether MRCS performance can predict future surgical career outcomes and competitiveness in training. Method All UK candidates who attempted MRCS between 2007-2020 were matched to career outcome data using the GMC list of registered medical practitioners and anonymised (n = 2910). Chi-squared tests determined associations with first attempt MRCS pass/fail outcomes. Multinomial regression models were developed to establish the predictive power of success at MRCS in determining surgical specialty and training deanery choices. Results There was statistically significant variability in MRCS Part A pass rates, ranging from 55.1%-76.7% between surgical specialties (P=0.001) but no significant variability in Part B pass rates (P=0.655). There was significant variability in Part A and Part B pass rates between training deaneries (P=0.010 and P=0.036 respectively). Pass rates ranged from 59.9%-77.7% for Part A and 70.1%-85.0% for Part B between training deaneries. Those in more competitive specialties and training deaneries performed better in MRCS in terms of first attempt pass rate, scores and number of attempts taken to pass. Conclusions MRCS performance is an early predictor of surgical career choice and competitiveness. Trainees who perform well at MRCS are more likely to enter competitive surgical specialties and training deaneries.

432 What Are the Promoting and Discouraging Factors for Choosing A Career in Surgery According to Undergraduate Medical Students in A District General Hospital? A Questionnaire and Review of The Literature

Abstract Introduction The aim was to identify which factors promote and discourage undergraduate medical students, based in a district general hospital, for choosing a career in surgery. A review of the current literature on this topic was undertaken in conjunction with the questionnaire. Method An online structured questionnaire was sent to all undergraduate clinical medical students based in Northumbria Specialist Emergency Care Hospital (NSECH), a teaching DGH. As well as the questionnaire, a systematic review of the literature was conducted on EMBASE, MEDLINE and Google Scholar using key search terms to review factors that influenced surgical career choices. Results The response rate was 46% (44/95). 75% of students rated variety of work, intellectually interesting and environment as the most important factors for their future careers. Status, financial rewards, and research opportunities were least important influences for respondents’ career decision making. A systematic literature review highlights that lifestyle factors, work-life balance were particularly important, perceived prestige and financial rewards were associated surgical career choices amongst medical students. Conclusions Multiple factors influence medical students career decision making and it is important to identify these factors for many reasons. Further research is recommended to further explore medical students’ perceptions on promoting and discouraging factors for surgical careers.

Women in thoracic surgery: European perspectives.

During the last decades, women have been discouraged from entering the medical career and in particular in the surgical specialties. This situation is changing across continents and national and international initiatives are supporting aspiring female surgeons in pursuing the surgical career through mentorship and fellowship programmes. Due to the differences in training programmes, Health Care systems and cultural backgrounds, it’s not easy to describe unanimously the pathways and obstacles that junior female thoracic surgeons are experiencing in Europe. The development of female surgical associations, mentorship programmes and national initiatives will further champion the gender equality in this specialty across Europe. During the recent years, the European Society of Thoracic Surgeons (ESTS) has established initiatives like the first ESTS Women in Thoracic Surgery Scientific Session or the annual Women in Thoracic ESTS Reception during the Annual Conference, which are done in an effort to encourage all female colleagues to join this specialty and increase the opportunity to share their experience and meet potential mentors. In this article we will depict the situation in some of the European countries whose female thoracic surgeons have led their way. We aim to give the next generation the examples that can influence women’s choice of surgical career, and the possible strategies and initiatives to reduce the gender discrimination within healthcare.

Perception, Academic Performance, Gender Judgment and Barriers among Surgeons' Career Progression in Jeddah, Saudi Arabia: A Cross-Sectional Study

IntroductionGender discrimination continues to be an issue in different surgical subspecialties, especially in Saudi Arabia, where no studies have been conducted so far on female surgeons in academia, on gender discrimination, and on job satisfaction. Considering the increasing number of women enrolling for surgery programs in Jeddah, Saudi Arabia, this study aims to examine their perceptions about and equity in working as surgeons. MethodsFollowing the STROCSS criteria, cross-sectional analyses were conducted of survey data from a multicentric online questionnaire in 2019/2020. A representative sample of medical interns and surgeons (n = 100) from Saudi Arabia responded out of 400 from the 4th iteration. ResultsFemales were 53%; most participants were less than 40 years. Women ranked assistant professors were fewer than men (2% vs. 11%). The number of publications by females vs. males was 2.58 +/– 2.68 vs. 11.37 +/– 20.53 (p = 0.002). Surgery was not considered a profession conducive to family life according to more than half the women citing lack of flexible/part-time training or work (26/53, or 49%). However, only 1/5, or 9/47 (19.1%), of men thought there was gender attitude/bias; men also had more variety in surgical career choices. Further, most patients preferred male surgeons ( p = 0.026). Both females (30/53 or 56.6%) and males (25/47 or 53.2%) agreed that the best response to an offensive question was to ignore it. Decision in choosing their specialty was influenced mostly by career and promotion prospects, enthusiasm, and commitment (females: 31/53 or 58.5% and males: 17/47 or 36.2%) with p = 0.026. ConclusionsThe findings reveal the persisting discrepancies based on gender in the surgical field in Saudi Arabia. A nationwide movement limiting working hours, encouraging medical students to enter surgery, and upholding women in leadership positions can help in overcoming this situation.

Are we reaping what we sow? Gender diversity in surgery: a survey of medical students

BackgroundA survey of medical students from the Royal College of Surgeons in Ireland (RCSI) at Dublin, Perdana and Penang in Malaysia was undertaken in an attempt to explore attitudes towards...

Women in surgery: challenges and opportunities

Women have been involved in surgery throughout history. However, despite the fact that there are now as many female medical students compared with male students in universities, men still significantly outnumber women in a number of procedural specialties, most notably surgery. This article discusses the factors that can influence women’s choice of surgical career, and the challenges and discrimination that women can face as surgeons. There is a strong argument for substantive policy change at the individual, organizational, and governmental level to reduce gendered discrimination and gendered stereotypes in surgery. We call upon all organizations involved in surgery, and particularly in the emerging field of global surgery, to actively work toward equity.

Surgical Career Choices in Medical Students: Timing, Stability and Important Factors

Gill, Roop; Massey, Virgil; Kimbrough, Mary K. MD, FACS; Mizell, Jason S. MD, FACS; Bentley, Frederick R. MD, FACS; Thrush, Carol R. Author Information

Roles of Mentorship and Research in Surgical Career Choice: Longitudinal Study of Medical Students

Roles of Mentorship and Research in Surgical Career Choice: Longitudinal Study of Medical Students

Factors influencing US medical students' decision to pursue surgery

BackgroundInterest and applications to surgery have steadily decreased over recent years in the United States. The goal of this review is to collect the current literature regarding US medical students' experience in surgery and factors influencing their intention to pursue surgery as a career. We hypothesize that multiple factors influence US medical students' career choice in surgery. MethodsSix electronic databases (PubMed, SCOPUS, Web of Science, Education Resources Information Center, Embase, and PsycINFO) were searched. The inclusion criteria were studies published after the new century related to factors influencing surgical career choice among US medical students. Factors influencing US medical student surgical career decision-making were recorded. A quality index score was given to each article selected to minimize risk of bias. ResultsWe identified 38 relevant articles of more than 1000 nonduplicated titles. The factors influencing medical student decision for a surgical career were categorized into five domains: mentorship and role model (n = 12), experience (clerkship n = 9, stereotype n = 4), timing of exposure (n = 9), personal (lifestyle n = 8, gender n = 6, finance n = 3), and others (n = 2). ConclusionsThis comprehensive systemic review identifies mentorship, experience in surgery, stereotypes, timing of exposure, and personal factors to be major determinants in medical students' decisions to pursue surgery. These represent areas that can be improved to attract applicants to general surgery residencies. Surgical faculty and residents can have a positive influence on medical students' decisions to pursue surgery as a career. Early introduction to the field of surgery, as well as recruitment strategies during the preclinical and clinical years of medical school can increase students' interest in a surgical career.

A mentorship-based preclinical elective increases exposure, confidence, and interest in surgery

BackgroundThe predicted shortage of surgeons is of growing concern with declining medical student interest in surgical careers. We hypothesized that earlier exposure to operative experiences and the establishment of resident mentors through a preclinical elective would enhance student confidence and interest in surgery. MethodsWe developed a preclinical elective in surgery, which served as an organized curriculum for junior medical students to experience surgery through a paired resident-mentorship model. We assessed student exposure and confidence with clinical activities before and after the elective (N = 24, 100% response rate). We compared these students with a cohort of peers not enrolled in the elective (N = 147, 67% response rate). ResultsWe found significantly improved confidence (2.8 vs 4.4) and clinical exposure (2.4 vs 4.3) before versus after the elective, with precourse scores equal to matched peers. ConclusionsThis elective incorporates elements that have been shown to positively influence student decision making in surgical career choice. The mentorship model promotes residents as educators, whereas the elective provides a means for early identification of students interested in surgery.

Australian medical students and their choice of surgery as a career: a review

Surgery is an emotionally, physically and mentally challenging profession, and medical students factor in many variables when choosing surgery as a career choice. The aim of this study is to review the available literature on the factors influencing Australian medical students' choice of surgery as their career. A search of EMBASE and MEDLINE with the search terms 'medical students' AND 'surgery'; 'medical students' AND 'career pathways'; 'medical students' AND 'career choices' was conducted. Additionally, Google Scholar and the reference list of some articles were canvassed for suitable areas of study. Lifestyle factors were the main reason influencing medical student's career choices. A balance between work, family and lifestyle was found to be important, and a surgical career choice was not always compatible with this. In particular, female students placed more importance on family and lifestyle factors when opting for non-surgical careers. Positive exposure and/or experiences in a surgical environment, perceived prestige and perceived financial reward were associated with surgical career choice. There is a need to better understand the factors influencing surgical and non-surgical career choice among Australian medical students, and develop appropriate interventions to promote surgery as a career. This article does not discuss personality traits of people who go into surgery.

Surgical Interest and Surgical Match for Third-Year Students: Results of a Prospective Multivariate Longitudinal Cohort Study

Numerous factors have been linked to surgical career choice, including the quality of third-year surgical clerkship. The vast majority of studies also selectively evaluate one or only a few variables that link to surgical career choice, so relative impact cannot be assessed. This study simultaneously evaluates the majority of variables linked to surgical career choice in previous research so that the relative contributions of each of these variables with respect to surgical career choice can be determined. Surveys before, during, and after the third-year surgical clerkship included student demographics, background, and values (eg, importance of money, controllable lifestyle), and student reactions to the third-year surgical clerkship. The dependent variables in this study included interest in surgery at the beginning and end of the clerkship and matching into a surgical residency. Both univariate and multivariate analyses generally supported findings in the literature, but the strengths of these associations reported previously might not have been accurate. In this study, the surgical resident match odds ratio for students starting the clerkship already knowing they wanted to be a surgeon was 22.46; the next highest associations were 4.65 and 3.37, which corresponded to earlier exposure to a surgical specialty and earlier exposure to general surgery, respectively. Differences in career choice for general surgeons and surgical specialists were also explored. Although the experience of the clerkship is related to career choice, the largest impact of the clerkship is for those already interested in a surgical career. Interest in a surgical career largely develops before the third-year clerkship. Implications of the results for recruiting greater numbers of students into surgical careers are discussed.

Under representation of women in surgery in Nigeria: by choice or by design?

Female Doctors' lack of interest in surgical careers has raised much concern in recent times. An understanding of the factors responsible for this lack of interest and evolving attitude is needed. The aim of this report was to determine the local factors that may be responsible and the most likely surgical specialty female doctors would prefer. This is a cross sectional study involving all female (consultant and resident) doctors in one teaching hospital. Information was obtained using a structured questionnaire which determined what formed the respondent's choice of present specialty. It also included the likely local factors that might have some bearings on the interest of female doctors in surgery. Data obtained were analyzed using SPSS version 11.5. There were a total of 105 respondents. The age range was 26 - 63 years (mean: 26.88+2.19). The factors that were considered as deterrents to female doctor choice of surgical career were: a) the impact on their time for family and other social engagements 29 (27.6%); b) heavy work load 22 (21%); c) involvement of a lot of physical effort 18 (17.1%); d) lack of women in surgery 9 (8.6%); and e) lack of role models 4 (3.8%). Twenty three (21.9%) considered all the above factors. The subspecialty preferred by most female was plastic and reconstructive surgery, followed by Pediatric surgery. The rigorous requirements of the training and practice of surgery deterred female doctors' interest in choosing and sustaining a surgical career. To maintain surgery as a premier career choice, female doctors should find surgery to be professionally and personally rewarding.

Upcoming female preponderance within surgery residents and the association of sex with the surgical career choice in the new millennium: results from a national survey in France

BackgroundWomen are increasingly entering the medical studies. We aim to investigate surgical residents' career decision making among surgical residents and to assess the presence of women. MethodsAn “electronic questionnaire” of self-assessment was distributed to the 2,500 current French surgical residents. Items analyzed included population characteristics, demographics, educational experiences, and choice of career. ResultsThere was a response rate of 31.2% (n = 779). The male/female ratio was 1.1 with 370 women (47.5%). The mean age was 28 ± 2 years. All surgical specialties were represented. Sex was significantly associated with the choice of surgical specialty (P < .05). Female residents had a shorter working time per week than male residents (P < .001). Sex was significantly linked with future career plans as female residents expected to work in a public hospital (P = .005) and as male residents expected to work in private practice (P = .001). ConclusionsFemale surgical residents are more populous than ever among surgical residents. Sex appears to be linked with where and how the residents expect to work in the future.

WS01 THE SWIM (SURGEONS AND WOMEN'S INITIATIVE TO MENTOR) PROGRAM

Background: There is a notable disparity between female representation in undergraduate medical courses and surgical faculty. The authors investigated the factors that influence female surgeons’ career choices and decisions to pursue academia. Role models and mentors strongly influenced respondent's surgical career choices and progression. Under‐exposure to same‐sex role models and a lack of available mentors in academic surgery were identified as barriers to pursuing academic careers (1).Aim: To pilot SWIM as a formal, surgical mentorship program targeting young female surgical trainees in Western Australia from March through November, 2009, with a view to long‐term continuation.Objectives: The goals of SWIM are to establish a professional network of female surgeons in WA; mentor and guide female surgical trainees; raise the profile of women in academic surgery; encourage female surgical trainees to participate in health and medical research; increase the number of female academic surgeons within the School of Surgery at the University of Western Australia.Methods: Participants briefed and paired; regular, face‐to‐face meetings; relationship driven by the trainee; guest speaker evening; networking breakfast; e‐newsletter; annual research publication award.Expected Outcomes: Participation will result in surgical trainees gaining support and career advice whilst building professional networks; mentors gaining personal satisfaction, identifying protégés for future collaboration and broadening their skill sets; the promotion of gender equity and diversity within the UWA School of Surgery.